Is gender policy related to the gender gap in external cause and circulatory disease mortality? A mixed effects model of 22 OECD countries 1973–2008

BMC Public Health

Staffan Marklund²  Antonio Ponce de Leon³  Bo Burström¹  Mona Backhans¹ 

[1] Department of Public Health Sciences, Karolinska Institutet, Stockholm, 171 76, SWEDEN;Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, 171 76, SWEDEN;Department of Epidemiology, Instituto de Medicina Social, Rio de Janeiro State University, Rio De Janeiro, BR-20550011, Brazil

关键词: Time series data;    Country comparison;    Mortality gaps;    Gender equality;    Gender policy;   

Others  :  1162856
DOI  :  10.1186/1471-2458-12-969

 received in 2011-12-15, accepted in 2012-10-18,  发布年份 2012

【 摘 要 】

Background

Gender differences in mortality vary widely between countries and over time, but few studies have examined predictors of these variations, apart from smoking. The aim of this study is to investigate the link between gender policy and the gender gap in cause-specific mortality, adjusted for economic factors and health behaviours.

Methods

22 OECD countries were followed 1973–2008 and the outcomes were gender gaps in external cause and circulatory disease mortality. A previously found country cluster solution was used, which includes indicators on taxes, parental leave, pensions, social insurances and social services in kind. Male breadwinner countries were made reference group and compared to earner-carer, compensatory breadwinner, and universal citizen countries. Specific policies were also analysed. Mixed effect models were used, where years were the level 1-units, and countries were the level 2-units.

Results

Both the earner-carer cluster (ns after adjustment for GDP) and policies characteristic of that cluster are associated with smaller gender differences in external causes, particularly due to an association with increased female mortality. Cluster differences in the gender gap in circulatory disease mortality are the result of a larger relative decrease of male mortality in the compensatory breadwinner cluster and the earner-carer cluster. Policies characteristic of those clusters were however generally related to increased mortality.

Conclusion

Results for external cause mortality are in concordance with the hypothesis that women become more exposed to risks of accident and violence when they are economically more active. For circulatory disease mortality, results differ depending on approach – cluster or indicator. Whether cluster differences not explained by specific policies reflect other welfare policies or unrelated societal trends is an open question. Recommendations for further studies are made.

【 授权许可】

   
2012 Backhans et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Kim K-S, Lee Y, Lee Y-J: A multilevel analysis of factors related to poverty in welfare states. Soc Indic Res 2010, 99:391-404.
• [2]Kangas O, Palme J: Does social policy matter? Poverty cycles in OECD countries. Int J Health Serv 2000, 30:335-352.
• [3]Bradley D, Huber E, Moller S, Nielsen F, Stephens JD: Distribution and redistribution in postindustrial democracies. World Politics 2003, 55:193-228.
• [4]Espelt A, Borrell C, Rodríguez-Sanz M, Muntaner C, Pasàrin MI, Benach J, Schaap M, Kunst AE, Navarro V: Inequalities in health by social class dimensions in European countries of different political traditions. Int J Epidemiol 2008, 37:1095-1105.
• [5]Borrell C, Espelt A, Rodríguez-Sanz M, Burström B, Muntaner C, Pasàrin MI, Benach J, Marinacci C, Roskam A-J, Schaap M, Regidor E, Costa G, Santana P, Deboosere P, Kunst A, Navarro V: Analyzing differences in the magnitude of socioeconomic inequalities in self-perceived health by countries of different political tradition in Europe. Int J Health Serv 2009, 39:321-341.
• [6]Eikemo TA, Bambra C, Judge K, Ringdal K: Welfare state regimes and differences in self-perceived health in Europe: A multilevel analysis. Soc Sci Med 2008, 66:2281-2295.
• [7]Chung H, Muntaner C: Welfare state matters: a typological multilevel analysis of wealthy countries. Health Policy 2007, 80:328-339.
• [8]Zambon A, Boyce W, Cois E, Currie C, Lemma P, Dalmasso P, Borracino A, Cavallo F: Do welfare regimes mediate the effect of socioeconomic position on health in adolescence? A cross-national comparison in Europe, North America, and Israel. Int J Health Serv 2006, 36:309-329.
• [9]Huijts T, Eikemo TA: Causality, social selectivity or artefacts? Why socioeconomic inequalities in health are not smallest in the Nordic countries. Eur J Public Health 2009, 19:452-453.
• [10]Dahl E, Fritzell J, Lahelma E, Martikainen P, Kunst A, Mackenbach J: Welfare state regimes and health inequalities. In Social inequalities in health. New evidence and policy implications. Edited by Siegrist J, Marmot M. Oxford University Press, Oxford; 2006:193-222.
• [11]Bambra C, Netuveli G, Eikemo TA: Welfare state regime life courses: The development of Western European welfare state regimes and age-related patterns of educational inequalities in self-reported health. Int J Health Serv 2010, 40:399-420.
• [12]Eikemo TA, Bambra C, Joyce K, Dahl E: Welfare state regimes and income-related health inequalities: a comparison of 23 European countries. Eur J Public Health 2008, 18:593-599.
• [13]Eikemo TA, Huisman M, Bambra C, Kunst AE: Health inequalities according to educational level in different welfare regimes: a comparison of 23 European countries. Sociol Health & Illn 2008, 30:565-582.
• [14]Coburn D: Beyond the income inequality hypothesis: class, neo-liberalism, and health inequalities. Soc Sci Med 2004, 58:41-56.
• [15]Navarro V, Muntaner C, Borrell C, Benach J, Quiroga A, Rodríguez-Sanz M, Vergés N, Pasàrin MI: Politics and health outcomes. Lancet 2006, 16:1033-1037.
• [16]Muntaner C, Lynch JW, Hillemeier M, Hee Lee J, David R, Benach J, Borrell C: Economic inequality, working class power, social capital, and cause-specific mortality in wealthy countries. Int J Health Serv 2002, 32:629-656.
• [17]Kangas O: One hundred years of money, welfare and death: mortality, economic growth and the development of the welfare state in 17 OECD countries 1900–2000. Int J Soc Welf 2010, 19(Special issue):S42-S59.
• [18]Lundberg O, Yngwe MA, Stjärne MK, Elstad JI, Kangas O, Norström T, Palme J, Fritzell J: NEWS Nordic Expert Group. The role of welfare state principles and generosity in social policy programmes for public health: an international comparative study. Lancet 2008, 372:1633-1640.
• [19]Stuckler D, Basu S, McKee M: Budget crises, health, and social welfare programmes. BMJ 2010, 341:77-79.
• [20]Chung H, Muntaner C: Political and welfare state determinants of infant and child health indicators: an analysis of wealthy countries. Soc Sci Med 2006, 63:829-842.
• [21]Macinco J, Starfield B, Shi LY: The contribution of primary care systems to health outcomes within Organization for Economic Cooperation and Development (OECD) countries, 1970–1998. Health Serv Res 2002, 38:831-865.
• [22]Lundberg O: Commentary: Politics and public health - some conceptual considerations concerning welfare state characteristics and public health outcomes. Int J Epidemiol 2008, 37:1105-1108.
• [23]Muntaner C, Borrell C, Espelt A, Rodríguez-Sanz M, Pasàrin MI, Benach J, Navarro V: Politics or policies vs politics and policies: a comment on Lundberg. Int J Epidemiol 2010, 39:1396-1397.
• [24]Muntaner C, Borrell C, Ng E, Chung H, Espelt A, Rodríguez-Sanz M, Benach J, O'Campo P: Review article: Politics, welfare regimes, and population health: controversies and evidence. Sociol Health & Illn 2011, 33:946-964.
• [25]Wisdom JP, Berlin M, Lapidus JA: Relating health policy to women's health outcomes. Soc Sci Med 2005, 61:1776-1784.
• [26]Wisdom JP, Michael YL, Ramsey K, Berlin M: Women's health policies associated with obesity, diabetes, high blood pressure, and smoking: a follow-up on the Women's Health Report Card. Women Health 2008, 48:103-122.
• [27]Bambra C, Pope D, Swami V, Stanistreet D, Roskam A, Kunst A, Scott-Samuel A: Gender, health inequalities and welfare state regimes: a cross-national study of 13 European countries. J Epidemiol Community Health 2009, 63:38-44.
• [28]Ferrera M: The 'Southern model' of welfare in social Europe. J Eur Soc Policy. 1996, 6:17-37.
• [29]Kawachi I, Kennedy BP, Gupta V, Prothrow-Stith D: Women's status and the health of women and men: A view from the States. Soc Sci Med 1999, 48:21-32.
• [30]Jun H-J, Subramanian SV, Gortmaker S, Kawachi I: A multilevel analysis of women's status and self-rated health in the United States. JAMWA 2004, 59:172-180.
• [31]Chen Y-Y, Subramanian SV, Acevedo-Garcia D, Kawachi I: Women's status and depressive symtoms: A multilevel analysis. Soc Sci Med 2005, 60:49-60.
• [32]Koenen KC, Lincoln A, Appleton A: Women's status and child well-being: A state-level analysis. Soc Sci Med 2006, 63:2999-3012.
• [33]Backhans MC, Lundberg M, Månsdotter A: Does increased gender equality lead to a convergence of health outcomes for men and women? A study of Swedish municipalities. Soc Sci Med 2007, 64:1892-1903.
• [34]Torsheim T, Ravens-Sieberer U, Hetland J, Välimaa R, Danielson M, Overpeck M: Cross-national variation of gender differences in adolescent subjective health in Europe and North America. Soc Sci Med 2006, 62:815-827.
• [35]Stanistreet D, Bambra C, Scott-Samuel A: Is patriarchy the source of men's higher mortality? J Epidemiol Community Health 2005, 59:873-876.
• [36]Gjonça A, Tomassini C, Vaupel JW: Male–female differences in mortality in the developed world. Max Planck Institute for Demographic Research, Rostock; 1999.
• [37]Weden MM, Brown RA: Historical and life course timing of the male mortality disadvantage in Europe. Epidemiologic transitions, evolution, and behavior. RAND Corporation, Santa Monica; 2007.
• [38]Henry L: Men's and women's mortality in the past. Population 1989, 44:177-201.
• [39]Trovato F, Heyen NB: A varied pattern of change of the sex differential in survival in the G7 countries. J Biosoc Sci 2005, 38:391-401.
• [40]Glei DA, Horiuchi S: The narrowing sex differential in life expectancy in high-income populations: Effects of differences in the age pattern of mortality. Popul Stud 2007, 61:141-159.
• [41]Trovato F, Lalu NM: Contribution of cause-specific mortality to changing sex differences in life expectancy: seven nations case study. Soc Biol 1998, 45:1-20.
• [42]Lopez AD, Collishaw NE, Piha T: A descriptive model of the cigarette epidemic in developed countries. Tob Control 1994, 3:242-247.
• [43]Pampel FC: Cigarette diffusion and sex differences in smoking. J Health Soc Behav 2001, 42:388-404.
• [44]Pampel FC: Cigarette use and the narrowing sex differential in mortality. Popul Dev Rev 2002, 28:77-104.
• [45]Pampel FC: Declining sex differences in mortality from lung cancer in high-income nations. Demography 2003, 40:45-65.
• [46]Bobak M: Relative and absolute gender gap in all-cause mortality in Europe and the contribution of smoking. Eur J Epidemiol 2002, 18:15-18.
• [47]Hitchman SC, Fong GT: Gender empowerment and female-to-male smoking prevalence ratios. Bull World Health Organ 2011, 89:195-202.
• [48]Nathanson CA: The position of women and mortality in developed countries. In Adult mortality in developed countries: from description to explanation. Edited by Lopez AD, Casel G, Valkonen T. Clarendon, Oxford; 1995:135-157.
• [49]Schaap M, Kunst AE, Leinsalu M, Regidor E, Espelt A, Ekholm O, Helmert U, Klumbiene J, Mackenbach JP: Female ever-smoking, education, emancipation and economic development in 19 European countries. Soc Sci Med 2009, 68:1271-1278.
• [50]Bourdieu P: Social distinction - A social critique of the judgement of taste. Routledge, London; 1984.
• [51]Sulkunen P: Drinking in France 1965–1979. An analysis of household consumption data. Br J Addict 1989, 84:61-72.
• [52]Huisman M, Kunst AE, Mackenbach J: Educational inequalities in smoking among men and women aged 16 years and older in 11 European countries. Tob Control 2005, 14:106-113.
• [53]Bourdieu P: What makes a social class? On the theoretical and practical existence of groups. Berkeley J Sociology 1987, 32:1-17.
• [54]Kruger DJ, Nesse RM: An evolutionary life-history framework for understanding sex differences in human mortality rates. Hum Nat 2006, 17:74-97.
• [55]Waldron I, McCloskey C, Earle I: Trends in gender differences in accidents mortality: Realtionships to changing gender roles and other societal trends. Demogr Res 2005, 13:415-454.
• [56]Sainsbury D: Women's and men's social rights: Gendering dimensions of welfare states. In Gendering welfare states. Edited by Sainsbury D. SAGE Publications, London; 1994.
• [57]Schofield T, Connell RW, Walker L, Wood JF, Butland DL: Understanding men's health and illness: A gender-relations approach to policy, research, and practice. J Ame Coll Health 2000, 48:247-256.
• [58]Backhans MC, Burström B, Marklund S: Gender policy developments and policy regimes in 22 OECD countries 1979–2008. Int J Health Serv 2011, 41:595-623.
• [59]Sainsbury D: Gender, policy regimes, and politics. In Gender and welfare state regimes. Edited by Sainsbury D. Oxford University Press, Oxford; 1999:245-275.
• [60]Castles FG, Mitchell D: Worlds of welfare and families of nations. In Families of nations: patterns of public policy in western democracies. Edited by Castles FG. Dartmouth, Aldershot; 1993:93-128.
• [61]Wilkinson RG, Pickett KE: Income inequality and population health: A review and explanation of the evidence. Soc Sci Med 2006, 62:1768-1784.
• [62]Marmot M: The influence of income on health: views of an epidemiologist. Health Aff 2002, 21:31-46.
• [63]Deaton A: Policy implications of the gradient of health and wealth. Health Aff 2002, 21:13-30.
• [64]Goldstein H, Browne WJ, Rasbah J: Tutorial in biostatistics. Multilevel modelling of medical data. Stat Med 2002, 21:3291-3315.
• [65]Merlo J, Chaix B, Yang M, Lynch J, Rastam L: A brief conceptual tutorial of multilevel analysis in social epidemiology: linking the statistical concept of clustering to the idea of contextual phenomenon. J Epidemiol Community Health 2005, 59:443-449.
• [66]Goldstein H, Woodhouse G: Modelling repeated measurements. In Multilevel modelling of health statistics. Edited by Leyland AH, Goldstein H. John Wiley & Sons, Chichester; 2001:13-26.
• [67]Snijders TAB, Bosker RJ: Longitudinal data. In Multilevel analysis. An introduction to basic and advanced multilevel modeling. Sage Publications, London; 1999:166-199.
• [68]Rasbash J, Charlton C, Jones K, Pillinger R: A new method for estimating autocorrelated errors in continuous time. In Manual supplement for MLwiN Version 2.14. Centre for Multilevel Modelling, University of Bristol: Bristol; 2009:68-72.
• [69]Rasbah J, Steele F, Browne WJ, Goldstein H: A User's Guide to MLwiN. Version 2.10. University of Bristol. Centre for Multilevel Modelling, Bristol; 2009.
• [70]Muazzam S, Nasrullah M: Macro determinants of cause-specific injury mortality in the OECD countries: an exploration of the importance of GDP and unemployment. J Community Health 2011, 36:574-582.
• [71]Gerdtham UG, Ruhm CJ: Deaths rise in good economic times: evidence from the OECD. Econ Hum Biol 2006, 4:298-316.
• [72]Vieratis LM, Britto S, Kovandzic TV: The impact of women's status and gender inequality on female homicide victimization rates. Fem Criminol 2007, 2:57-73.
• [73]Korpi W: Faces of inequality: Gender, class, and patterns of inequality in different types of welfare states. Social Politics 2000, 7(2):127-191.
• [74]Pfau-Effinger B: Conclusion. In Gender, economy and culture in the European Union. Edited by Duncan S, Pfau-Effinger B. Routledge, London; 2000:279-293.
• [75]Blakely TA, Woodward AJ: Ecological effects in multi-level studies. J Epidemiol Community Health 2000, 54:367-374.
• [76]Esping-Andersen G: The three worlds of welfare capitalism. Polity Press, Cambridge; 1990.
• [77]Bambra C: Sifting the wheat from the chaff: a two-dimensional discriminant analysis of Welfare State Regime theory. Soc Policy Adm 2007, 41:1-28.